Longitudinal case based presentations in HCM

Abstract

A significant volume of data has been published over the past several years regarding HCM, yet only recently in 2011 has the ACCF/AHA issued guidelines for management and diagnosis. Nonetheless, the acute and chronic management of HCM is highly nuanced, based on collective experience of a large number of patients. In order to elucidate the subtleties of management, seven carefully selected cases from our HCM center attempt to depict the medical decision making process at various stages of illness. Case 1 is a middle-aged male with refractory NYHA Class III symptoms who eventually improved after undergoing surgical septal reduction. Case 2 is a young female with history of sudden death and refractory symptoms who required invasive therapy and a successful alcohol septal ablation was performed due to strong patient preference. Case 3 is a young female without significant outflow tract obstruction but with advanced diastolic heart failure who eventually required a heart transplant. Case 4 depicts severe obstructive HCM in a female with advanced age who after an extended course of medical therapy eventually improved post alcohol septal ablation. Case 5 is a relatively young female post ICD for SCD with ICD lead complications and atrial fibrillation well managed medically. Case 6 is a middle aged male with severe obstructive HCM who required invasive therapy eventually and preferred alcohol septal ablation to surgery. Case 7 is a patient with obstructive HCM referred for alcohol septal ablation who was subsequently determined to have a subaortic membrane and ultimately required surgical treatment. As will become clear, appropriate care of HCM patients requires an individualized and comprehensive approach keeping in view their specific and oftentimes changing presentation, currently available data, and guidelines, all within the confines of a dedicated HCM center.